Connecticut Application

All submissions via VetFuel.org become the property of the organization VetFuel, Inc., which is a 501-c3 non-profit organization, created with the assistance of Yale Law School’s Jerome N. Frank Legal Services Organization— since 2014.

VetFuel, Incorporated, will not share, nor sell, your personally identifiable information with any third party. All personally identifiable information, with the exception of demographic information, is destroyed once the application is completed. By entering into this agreement, you allow VetFuel, Inc. its board, and legal advisors to use this information in a manner consistent with the application & support of VetFuel’s operations. By requesting assistance, you relinquish VetFuel, Inc. from all liability & hold harmless its board, its members, its funders, & agent; relinquishing your right to suit in perpetuum.

Name *

First Name

Last Name

Email *

Phone Number where we can leave a message *

Connecticut Address *

Please submit the Veteran's Connecticut mailing address here. If the Veteran is homeless, please use the current homeless shelter as the address.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Age *

Gender *

Race *

Highest Level of Education Completed *

Employment Status *

Full Time

Part Time

Unemployed & looking for work

Unable to work

Gross Monthly Income *

Marital Status *

Number of people in your household including children *

Discharge Status *

Branch of Military Service *

Rank at time of dischage *

Number of years of military service *

Were you exposed to an Open-Air Burn Pit, Gulf War Syndrome, "Bad Water" or other Cancer causing Carcinogens? *

Yes

Which country were you exposed in?

Afghanistan

Djibouti

Iraq

Kuwait

Oman

Saudi Arabia

If you are seeking Federal Clemency, a State based Pardon or a Certificate of Employability from the Connecticut Board of Pardons & Paroles, please state your charges at the time of arrest. You must be five years post-conviction to seek a pardon. Please include docket numbers if you have them. *

The Connecticut Return of Fingerprints Program erases the Connecticut Department of Public Safety record of arrest for Nolled misdemeanors, “crimes where the prosecutor has decided not to pursue”. While the case may not be prosecuted by the court, the State of CT. Department of Public Safety retains a record of the arrest. Please let us know if you are interested in this application process & the historical docket numbers. *

The State of Connecticut Return of

Are you currently experiencing homelessness in the State of Connecticut? *

Thank you for your service to the greatest Country in the world. A VetFuel team member will contact you within 72 hours. After we contact you, you must submit documentation showing that you are a veteran.

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VetFuel™, Inc.

vetfuel@gmail.com

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A Message From Drew Messore, M.S., M.P.H. about the work we do every day to “Create, Maintain, & Preserve An Ever Present Beacon Of Social Justice For Connecticut’s Veterans.

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